Women Face Higher Long COVID Risk — Especially After 40

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A new study found that women are more likely to develop long COVID-19 than men, particularly for those between the ages of 40 and 55. Investigators discovered that the risk varies based on age, pregnancy and menopause status. These differences could help doctors better treat and prevent long COVID in different groups.

Although most individuals who have contracted COVID-19 — a virus that has infected approximately 777 million people and is responsible for 7 million deaths — recover from their illness, many experience the lasting effects of long COVID. Just as the initial infection varies in severity, the risk of developing long COVID may differ among certain populations.

To better understand the role sex differences play in the risk of developing long COVID, investigators collected information from 12,276 people enrolled in the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER)–Adult cohort between October 2021 and July 2024 who had a qualifying study visit six or more months after COVID infection. The RECOVER-Adult group is the largest natural history study of long COVID to date and includes nationwide-level data on the symptoms and clinical characteristics of all patients. Participants filled out symptom surveys every three months and received an in-person physical examination with laboratory studies at least once a year.

“A substantial number of individuals worldwide experience long COVID, or post-COVID condition,” wrote a team of investigators led by Dimpy P. Shah, M.D., Ph.D., assistant professor at the University of Texas Health Science Center. “Other postviral and autoimmune conditions have a female predominance, but whether the same is true for long COVID, especially within different subgroups, is uncertain.”

Cases of long COVID were identified using the self-reported questionnaire and scoring guideline given at patients’ first visit post-COVID. Investigators evaluated demographic and clinical characteristics of the cohort along with social determinants of health to determine the most at-risk populations for developing the condition.

Most patients were women (73%) and White (57%), and the mean age at infection was 46 years. Compared with women, male participants were older (median age 52 years versus 42 years, respectively) and had lower rates of obesity (21% versus 30%, respectively) and mental health conditions (26% versus 40%, respectively). However, they had higher rates of hospitalization during the acute infection period (10% versus 7%, respectively).

Female sex was linked to a higher risk of long COVID in both the primary full model and the reduced model — which accounted for age, race and ethnicity. This trend was seen across all age groups except for those aged 18 to 39 years. This risk was significantly higher when investigators restricted the analysis to nonpregnant participants. For people aged 40 to 54 years, menopausal women were about 42% more likely to develop long COVID compared with men, while nonmenopausal women had a 45% higher risk .

Investigators noted that using the large and socioeconomically diverse RECOVER cohort was a strength of their study. However, the data may have been subject to reporting bias if women were more likely to report their symptoms and selection bias if women were more likely to enroll in the study. Additionally, they were unable to obtain data about sex hormone levels, hormone-related medication use, pregnancy-related complications or the timing of infection in relation to the menstrual cycle. Lastly, the study lacked a control group.

“Understanding the mechanisms of sex differences can provide preventive and management strategies for not only long COVID but also other postviral illnesses,” investigators concluded.